Pickwell et al identified patients with infected diabetic foot ulcers who may need to undergo amputation. This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in Europe and are members of the European Study Group on Diabetes and the Lower Exremity (Eurodiale).
Patient selection: infected diabetic foot ulcer
Parameters:
(1) sex
(2) peripheral arterial disease (PAD) and ankle-brachial index (ABI)
(3) pain or tenderness on palpation
(4) area of the ulcer in square cm
(5) depth of the ulcer
(6) periwound edema
|
Parameter
|
Findings
|
Points for Score 1
|
Points for Score 2
|
|
sex
|
female
|
0
|
0
|
|
|
male
|
0.5
|
1
|
|
PAD
|
absent
|
0
|
0
|
|
|
present with ABI >= 0.5
|
1
|
1
|
|
|
present with ABI < 0.5
|
1.5
|
2
|
|
pain or tenderness
|
absent
|
NA
|
0
|
|
|
present
|
NA
|
0.5
|
|
ulcer area
|
< 1 square cm
|
NA
|
0
|
|
|
1 to 5 sq cm
|
NA
|
0.5
|
|
|
> 5 sq cm
|
NA
|
1
|
|
ulcer depth
|
superficial
|
0
|
0
|
|
|
deep without probe reaching bone
|
1.5
|
1
|
|
|
deep with probe reaching bone
|
2
|
2
|
|
periwound edema
|
absent
|
0
|
NA
|
|
|
present
|
0.5
|
NA
|
score 1 = any amputation =
= SUM(points for 4 parameters)
score 2 = amputation excluding lesser toes =
= SUM(points for 5 parameters)
Interpretation:
• minimum for score 1 and score 2: 0
• maximum score 1: 4.5
• maximum score 2: 6.5
• Based on the data in the ROC curves (Figure 1) score 1 >= 3 and score 2 >= 3.5 appear to be good cutoffs.
• The presence of moderate or severe infection further increases the risk of amputation.
Performance:
• The area under the ROC curve for score 1 was 0.80 and for score 2 0.78.
